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Bronchiolitis in infancy: Respiratory syncitial virus-induced bronchiolitis remains one of the commonest and most important reasons for hospitalisation of infants, accounting for 90 000 admissions per annum in the USA and 4500 deaths, mostly in those aged <6 months. Preterm infants (especially those with residua of lung disease) and infants with underlying lung and/or heart disease are at particular risk. Infection control strategies, bronchodilators, steroids, interferon and ribavirin have all been used to manage established disease, with variable results in terms of impact on the course of disease and/or subsequent status of affected infants. Surfactant has also been used where assisted ventilation has been necessary. Recent work suggests that natural infection does not boost virus-specific T-cell immunity, with ~40% of a study population which was hospitalised in one year being re-infected the next winter. Serious adverse outcomes following vaccine trials in the 1960s and lack of knowledge and understanding of the immune response in infants has meant that active immunisation is currently not available. Sub-unit vaccines have been tested over the past two decades, but it will probably be at least 5-10 years before routine immunisation becomes available. Read more: Pediatr Infect Dis J 2002;21:685-96 Curr Opin Pulm Med 2002;8:214-7 Pediatr Res 2002; 52:363-7 |